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General NPI Number Information
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NPI Number | 1235477506
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURE - ANDERSON, P. C.
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 3004 N MAIN ST
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City | ANDERSON
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State | SC
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Zip | 29621-2761
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Country | US
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Telephone | 864-224-8106
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Fax | 864-261-2429
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Provider Business Mailing Address
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Address Line | 3004 N MAIN ST
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City | ANDERSON
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State | SC
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Zip | 29621-2761
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Country | US
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Telephone | 864-224-8106
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Fax | 864-261-2429
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID RAY HUDNALL
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Credential | DMD
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Telephone | 864-224-8106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3086
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3405
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License Number State | SC
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